| NPI | 1467947416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: NY 044616) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0003928) |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2021-04-13 |